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Charles Bonnet Syndrome
Charles Bonnet: French philosopher and natural scientist born March 13, 1720.
Geneva died May 20, 1793. Genthod near Geneva.
Differential Diagnosis of Recurrent
Complex Visual Hallucinations
1. Medication(s)
2. Metabolic status
3. Psychiatric etiology including mania,
depression, substance dependence and
schizophrenia
4. Neurodegenerative diseases (e.g Lewy
Body Dementia, Alzheimer’s and
Parkinson’s disease)
5. Release hallucinations – Charles Bonnet
Syndrome
Release Hallucinations: Charles
Bonnet Syndrome
Characterized by the triad:
1. Complex visual hallucinations (CVH)
2. Ocular pathology causing visual loss
3. Absence of cognitive impairment
Charles Bonnet described a case of
complex hallucinations due to visual loss
association with cataracts in his cognitively
intact grandfather in 1760.
Complex Visual Hallucinations
The images are of normal size and shape
Very brightly colored
Fully recognized as flower floating, women
in caps, and images of men
Occasionally seen with eyes closed
Not completely obscuring her field of
vision but floating
Spontaneous Hallucinations
Figure 1. Spontaneous hallucinations. Positive
correlations between T2*-weighted MRI signal
and hallucination report are superimposed
(red) on transverse sections of high-resolution
structural images.
The fusiform gyrus has been shaded in blue to
aid anatomical localization. The hallucinations
are illustrated next to each image. Ventral
occipital activity was consistent in repeated
experiments on the same patient.
No areas had a negative correlation at the
same level of significance. In all figures, the left
of each structural image is the right of the
brain.
Figure 1. Spontaneous hallucinations.
Ffytche DH, Howard RJ, Brammer MJ, David A, Woodruff P, Williams S. The
anatomy of conscious vision: an fMRI study of visual hallucinations. Nat
Neurosci 1998: 742.
Figure 2. The factor analysis
of phenomenological
variables. The factor
analysis of
phenomenological variables.
Only the first three factors
are displayed. The core
variables of factor 1 are
shaded red, core variables
of factor 2 are shaded green
and core variables of factor
3 on the periphery of each
factor are enclosed by the
shaded border.
Santhouse AM, et al. Brain
2000, 123:2055-2064:
dot:10.
1093/brain/123.10.2055
Functional MRI
The image results implied that
1. Each specialized visual area had its own
associated hallucination and
2. The pathophysiology of the
hallucinations involved a localized
increase in cerebral activity.
Ffytche DH, Howard RJ, Brammer MJ, David A, Woodruff P, Williams S. The
anatomy of conscious vision: an fMRI study of visual hallucinations. Nat
Neurosci 1998: 742.
Three Visuopsycho-Syndromes
The first consisted of hallucinatons of
extended landscape scenes and small
figures in costumes with hats.
The second, hallucinations of grotesque,
disembodied and distorted faces with
prominent eyes and teeth; and the
third, visual perseveration and delayed
palinopsia.
Visuopsycho-Syndromes
The investigators hypothesized that the
three visuopsycho-syndromes mirror the
segregation of hierarchical visual pathway
interstreams and suggest a novel
theoretical framework for the
pathophysiology of three visual
syndromes.
Santhouse AM, et al. Brain 2000, 123:2055-2064: dot:10.
1093/brain/123.10.2055
Figure 3. Pathway streams for vision, the ventral stream leading to the temporal
lobe [visuopsycho-syndrome number 1] the dorsal stream leading to the parietal
lobe [visuopsycho-syndrome number 3].
Figure 4. A lateral and ventral view of the human brain. The brain regions
hypothesized as being related to the three visual psycho-syndromes are shaded.
The ventral occipitotemporal cortex activated by objects (Kanwisher et al. 1996,
Halgren et al. 1999) and extended scenes (Epstein and Kanwisher 1998) is shaded
red. The STS region sensitive to eye movements and gaze in face stimuli (Puce et
al 1998, Wicker et al 1998) is shaded green. The intra-parietal region containing
eye-centered reference frames (Duhamer et al 1992) is shaded yellow.
Visual Perseveration
The hypothesis that the third visuopsychosyndrome relates to the parietal projection
of the dorsal stream is supported by
Critchley’s observations in 1951, that
delayed palinopsia and visual
perseveration are associated with lesions
in the parietal lobe.
Critchley M. Types of visual perseveration: palinopsia and illusory visual
spread. Brain 1951 74:267-299.
References
Critchley M. Types of visual perseveration
‘palinopsia’ and ‘illustory visual spread’.
Brain 1951; 74:267-299.
Ffytche DH, Howard RJ, Brammer MJ,
David A, Woodruff P, Williams S. The
anatomy of conscious vision: an fMRI
study of visual hallucinations. Nat
Neurosci 1998; 1:738-742.
Santhouse AM, Howard RJ, Ffytche DH.
Visual hallucinatory syndromes and the
anatomy of the visual brain. Brain 2000;
123 (Pt 10): 2055-2064.
Schultz G, Melzack R. The Charles
Bonnet syndrome phantom visual images.
Perception 1991; 20: 809-825.
http://www.library.med.utah.edu/NOVEL
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Charles Bonnet Syndrome